自然、社会、建筑和政策环境对乳腺癌的影响。
The Impact of the Natural, Social, Built, and Policy Environments on Breast Cancer.
作者信息
Coughlin Steven S, Smith Selina A
机构信息
Department of Health Science and Sustainability, Division of Public Health, University of Massachusetts, Lowell, MA.
Institute of Public and Preventive Health, and Department of Family Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA.
出版信息
J Environ Health Sci. 2015;1(3). doi: 10.15436/2378-6841.15.020. Epub 2015 Aug 3.
BACKGROUND
The global burden of breast cancer in women is substantial and increasing. Efforts to address breast cancer have focused on primary prevention, reduction of modifiable risk factors, early detection, timely referral for appropriate treatment, and survivorship. Environmental and lifestyle factors that increase breast cancer risk include ionizing radiation, exogenous hormones, certain female reproductive factors, alcohol and other dietary factors, obesity, and physical inactivity. A variety of chemical exposures are purported to be associated with breast cancer.
METHODS
In this article, we summarize the influence of the natural, social, built, and policy environments on breast cancer incidence and cancer recurrence in women based upon bibliographic searches and relevant search terms.
RESULTS
Despite a lack of conclusive evidence from epidemiologic studies, exposures to chemicals with estrogenic or other properties relevant to sex steroid activity could influence breast cancer risk if the exposures occur at critical life stages or in combination with exposure to other similar chemicals. Results from several studies support an association between shift work and disruption of the circadian rhythm with breast cancer risk. The social environment likely influences breast cancer risk through several mechanisms including social norms pertaining to breast feeding, age at first live birth, parity, use of oral contraceptives and replacement estrogens, diet, and consumption of alcohol. Social norms also influence body weight, obesity, and physical activity, which have an effect on risk of breast cancer incidence and recurrence. Obesity, which is influenced by the social, built, and policy environments, is a risk factor for the development of postmenopausal breast cancer and certain other cancer types.
CONCLUSIONS
The natural, social, built, and policy environments affect breast cancer incidence and survival. Effective health care policies can encourage the provision of high-quality screening and treatment for breast cancer and public education about the value of proper diet, weight control, screening and treatment. Additional research and policy development is needed to determine the value of limiting exposures to potentially carcinogenic chemicals on breast cancer prevention.
背景
女性乳腺癌的全球负担沉重且呈上升趋势。应对乳腺癌的努力集中在一级预防、减少可改变的风险因素、早期检测、及时转诊以接受适当治疗以及生存关怀。增加乳腺癌风险的环境和生活方式因素包括电离辐射、外源性激素、某些女性生殖因素、酒精及其他饮食因素、肥胖和身体活动不足。据称多种化学物质暴露与乳腺癌有关。
方法
在本文中，我们基于文献检索和相关检索词总结了自然、社会、建筑和政策环境对女性乳腺癌发病率和癌症复发的影响。
结果
尽管流行病学研究缺乏确凿证据，但如果在关键生命阶段接触具有雌激素活性或其他与性类固醇活性相关特性的化学物质，或者与接触其他类似化学物质同时发生，可能会影响乳腺癌风险。多项研究结果支持轮班工作和昼夜节律紊乱与乳腺癌风险之间存在关联。社会环境可能通过多种机制影响乳腺癌风险，包括与母乳喂养、首次生育年龄、生育次数、口服避孕药和替代雌激素的使用、饮食以及酒精消费相关的社会规范。社会规范还会影响体重、肥胖和身体活动，而这些又会对乳腺癌发病和复发风险产生影响。受社会、建筑和政策环境影响的肥胖是绝经后乳腺癌及某些其他癌症类型发生的风险因素。
结论
自然、社会、建筑和政策环境会影响乳腺癌的发病率和生存率。有效的医疗保健政策可鼓励提供高质量的乳腺癌筛查和治疗，并开展关于合理饮食、体重控制、筛查和治疗价值的公众教育。需要进一步的研究和政策制定来确定限制接触潜在致癌化学物质对预防乳腺癌的价值。
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